Teens Find A Dangerous, Cheap
High In Cough Medicine
By Will Evans
Bee Staff Writer
The Sacramento Bee
1-31-4

The first time Myles did "skittles" was at
high school -- and all the teachers were giving him strange looks. The
curly haired sophomore couldn't control his forehead, couldn't put his
eyebrows down.

His hands were quivering, his knees spasming. He couldn't
walk straight.

Scary, this being his first time, and this was not expected.
A friend told him it would be like smoking a joint. But cough medicine
-- especially these Coricidin HBP pills, called skittles on the street
-- was "way more intense."

At a party that night, Myles played the punching game
bloody knuckles. He probably won, because he couldn't feel a thing, and
he woke up later with bashed-up hands.

Not feeling anything is a good feeling, says Myles, now
17, of Sacramento. But take it from him: "I actually don't recommend
taking the whole package."

The use of cough medicine to get high is rising among
teenagers nationwide and in the Sacramento region, according to poison-control
centers.

The hallucination-inducing ingredient is the cough suppressant
dextromethorphan (DXM). It's found in many over-the-counter medicines,
from Robitussin DM to DayQuil, which are safe at the recommended dosage.
Often, the medications contain other drugs harmful in the large quantities
necessary to get the DXM fix.

In particular vogue are the red pills of Coricidin HBP
Cough & Cold. The Sacramento division of the California Poison Control
System has seen an increase in calls related to abuse of the readily available
medicine.

"It has a pretty high concentration of the cough
suppressant, and we believe that's why it is one of the drugs of choice
for abuse," says Judith Alsop, division director.

Cough medicine is not one of the most dangerous or widespread
abused substances among young people.

Calls about teenagers misusing DXM doubled nationwide
from 2000 to 2003, according to the American Association of Poison Control
Centers, but the 3,271 cases of 2003 represent a tiny fraction of some
2.3 million total calls. Locally, high school students say it happens,
but it's not common.

But a few DXM-related deaths reported around the country
and the upswing in popularity has caused doctors, educators and industry
to take note.

This month, Walgreens nationwide began limiting the sale
of Coricidin HBP Cough & Cold to three packages per person, and some
stores now guard it behind the counter instead of putting it on the shelf.
The maker of Coricidin HBP, New Jersey-based Schering-Plough, worked with
the Partnership for a Drug-Free America to develop an online resource at
www.drugfreeamerica.org/dxm.

Despite those efforts, Web sites aimed at abusers of
the medication offer tips on what kind and how much cough medicine to down,
"fun" things to do while high, how to distill DXM powder from
medication and how to buy the powder in bulk.

But those finer points aside, much of the appeal, say
teenagers, is that it's cheap and easily available -- at the drugstore
or at home in the medicine cabinet.

"If you didn't have any money to get stoned, basically
you just drink a bottle," says Melissa Florez, a senior at McClatchy
High School who guzzled cough syrup a few times when she was feeling depressed
her sophomore year. "It seemed like the only thing to do was to get
high however I could, and if it came down to a bottle of cough syrup, that's
how it was."

But Florez, with pink bangs fringing her black hair and
peace signs piercing her ears, describes the high as a woozy "sick
feeling" and isn't a fan.

One of the biggest dangers of chugging syrup and popping
cold tablets comes from the active ingredients other than DXM, says Steve
Offerman, attending emergency physician at UC Davis Medical Center.

"These products, many of them are mixed with other
stuff, and you can get poisoning from that stuff as well," he says.

In high doses, the antihistamine in Coricidin HBP Cough
& Cold, for example, causes the heart to speed and symptoms of poor
coordination on top of DXM's effects. In large enough quantities, it could
even lead to a coma. Other preparations of Coricidin HBP and other cough
medicines include acetaminophen, or Tylenol, which can ruin the liver in
whopping doses.

Some cough medications, when taken to get high, could
cause heart attacks among people with a family history of cardiac problems
or seizures among people susceptible to attacks, says Alsop.

The heavy sedation of high doses could cause breathing
problems or lead people to damage their body by lying out in the cold,
Offerman says.

And sedation is sometimes blended with a "Hulk-ish"
hyperstimulation. Some young people seen by James Margolis of Sutter Center
for Psychiatry become violent and assault others when strung out on cough
suppressants. Others come in with self-induced cuts, he says.

Mike Walsh, a toxicology specialist who fields calls,
says the teens are usually sent to the hospital, given a nasty charcoal
liquid, monitored till the effects wear off and sent home.

Most young people who do drugs in general have tried
DXM, but most don't stick with it, in the experience of Jon Daily, an alcohol
and drug abuse counselor with New Directions Counseling Associates in Fair
Oaks.

He saw skittle abuse pop up last year and peak during
the summer. But it's still less than the popularity of other medicinal
highs, like that from Vicodin, Valium and Oxycontin, he says.

"Everybody was worried about kids smoking marijuana,
using crank and using alcohol," Margolis says. "What we're experiencing
is that probably two-thirds of drug abuse is stuff in the home or stuff
you can get in the drugstore."

Other ingredients to watch out for in cough medicine:
Chlorpheniramine: an antihistamine, which in high doses can cause increased
heart rate, dilated pupils, uncoordination and lethargy, and even lead
to seizures or a coma; Acetaminophen: a pain reliever otherwise known as
Tylenol, which in high doses can cause permanent liver damage; Pseudoephedrine:
a decongestant which in high doses can cause increased heart rate and blood
pressure, nervousness, agitation, irregular heartbeats and seizures